California Code of Regulations, Title 8 s1

California Code of Regulations, Title 8

Chapter 4.5. Division of Workers' Compensation

Subchapter 1.6. Permanent Disability Rating Determination

§10150. Authority.

§10151. Filing Requirements.

§10150.1. Signature dDisputes and the siSgnatures of cConsultants.

§10150.2. Technical Unavailability of EAMS.

§10150.3. Disability Evaluation Unit File Retention.

§10150.4. Misfiled or mMisdirected dDocuments.

§10151. Filing Requirements.

§10152. Electronic Filing Exemption

§10160. Summary Rating Determinations, Comprehensive Medical Evaluation of Unrepresented Employee.

§10160.1. Summary Rating Determinations, Report of Primary Treating Physician for Unrepresented Employee.

§10160.5. Summary Rating Determinations, Represented Employees.

§10161. Forms.

§10161.1. Reproduction of Forms.

§10162. Summary Rating Determinations, Apportionment.

§10164. Summary Rating Determinations, Reconsideration Iif Employee is Unrepresented.

§10165. Service of Summary Rating Determination and Notice of Options Following Permanent Disability Rating.

§10166. Consultative Ratings Determinations.

§10166.1. Form (Request for Consultative Ratings).

§10167. Informal Ratings.

§10168. Records, Destruction of

§10150. Authority.

The Disability Evaluation Unit, under the direction and authority of the Aadministrative Ddirector, will issue permanent disability ratings as required under this subchapter utilizing the Schedule for Rating Permanent Disabilities adopted by the Aadministrative Ddirector. The Disability Evaluation Unit will prepare the following kinds of rating determinations:

(a) Formal rating determinations

(b) Summary rating determinations

(d) Informal rating determinations.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 124, 4061, 4660, 4662, 4663 and 4664, Labor Code.

§10151. Filing Requirements.

(a) “Electronic Adjudication Management System” or “EAMS” means the computer case management system used by the Division of Workers’ Compensation to electronically store and maintain the Division of Workers’ Compensation or the appeals board’s case files and to perform other case management functions.

(b) All forms or correspondence submitted to the Disability Evaluation Unit shall be stored in the EAMS:

(1) Except for documents or forms which open a Disability Evaluation Unit file, all documents and forms shall contain a case number assigned by the Division of Workers' Compensation. The case number shall be preceded by the prefix "DEU". Case opening document shall be assigned a case number by the Division of Workers Compensation after filing. Documents or forms filed without a case number will be returned to the sender with instructions for proper filing.

(2) All documents presented for filing shall conform to the requirements of section 10232 of title 8 of the California Code of Regulations.

(3) All filed paper documents and forms shall be scanned into the EAMS and then will be destroyed. A properly filed electronic form or document or a properly filed paper document or form shall be deemed a legal filing for all purposes.

(4) The service of all documents and forms shall conform to the receiving party's designated preferred method of service described in section of 10218 of title 8 of the California Code of Regulation.

Authority cited: Sections 133, 4061, 4660, 5307.3 and 5307.4, Labor Code.

Reference: Sections 124 and 4061, Labor Code.

§10150.1. Signature dDisputes and the sSignatures of cConsultants.

(a) Anyone who disputes the authenticity of any signature must file with the Manager of the Disability Evaluation Unit an objection to the pleading or other document within ten (10) days of the filing of that document. The objection shall contain a complete explanation of the basis for the objection.

(b) The filing of a document, signed with a "/s/ name" or an electronic image of the signature filed with the login and password of the Division of Workers' Compensation consultant assigned to the case shall constitute an original signature for all purposes.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 124, 4061, 4062, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.

§10150.2. Technical uUnavailability of EAMS.

Technical problems with filing documents shall be governed by sections 10225 of title 8 of the California Code of Regulation.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 5502 and 5700, Labor Code.

§10150.3. Disability Evaluation Unit File Retention.

(a) Following a period of fifty (50) years after the filing of a document used to open a case or file, the Division of Workers’ Compensation may destroy the electronic and/or paper file in each case maintained by the Disability Evaluation Unit.

(b) The Division of Workers’ Compensation, at any time, may convert a paper file to an electronic file. If a paper case file has been converted to electronic form, the paper case file may be destroyed. The Division of Workers' Compensation shall inform the parties when a paper file is converted. If a paper case file has been converted to electronic form, the paper case file may be destroyed no less than 30 business days after the parties have been informed of the conversion.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 124, 4061, 4062, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.

§10150.4. Misfiled or mMisdirected dDocuments.

(a) A request to move or substitute a corrected a document shall be made in conformity with section 10223 of title 8 of the California Code of Regulation, except that a written request to substitute with the proposed document for substitution appended shall be made in lieu of a petition to substitute as allowed under section 10223(b). The authority to approve moving a document from one file to another file shall reside with the Manager of the Disability Evaluation Unit or his or her designee.

(b) If a document is not filed in compliance with sections 10217, 10228 and 10232 of title 8 of the California Code of Regulations and these regulations, the administrative director may in his or her discretion take the actions set forth in section 10222 of title 8 of the California Code of Regulations.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 124, 4061, 4062, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.

§10151. Filing Requirements.

(b) All forms or correspondence submitted to the Disability Evaluation Unit shall be stored in the EAMS:

(2) All documents presented for filing shall conform to the requirements of sections 10215, 10228 and 10232 of title 8 of the California Code of Regulations.

(3) All filed paper documents and forms shall be scanned into the EAMS and then will be destroyed. A properly filed paper document or form shall be deemed a legal filing for all purposes.

(4) The service of all documents and forms shall conform to the receiving party's designated preferred method of service described in section of 10218 of title 8 of the California Code of Regulation.

Authority cited: Sections 133, 4061, 4660, 5307.3 and 5307.4, Labor Code.

Reference: Sections 124 and 4061, Labor Code.

§10152. Electronic Filing Exemption

If a document is filed with EAMS as part of the electronic filing trial, that document does not need to be filed in compliance with sections 10228 and 10232 of title 8 of the California Code of Regulation.

Authority cited: Sections 111, 133, 5307.3 and 5307.4, Labor Code.

Reference: Sections 124 and 4061, Labor Code.

§10160. Summary Rating Determinations, Comprehensive Medical Evaluation of Unrepresented Employee.

(a) The Disability Evaluation Unit will prepare a summary rating determination upon receipt of a properly prepared request. A properly prepared request shall consist of:

(1) A completed Request for Summary Rating Determination, DWC AD DEU Form 101 (DEU);

(2) A completed Employee's Disability Questionnaire, DWC AD DEU Form 100 (DEU);

(3) A comprehensive medical evaluation of an unrepresented employee from a Qualified Medical Evaluator.

(b) The insurance carrier or self-insured employer shall provide the employee with an Employee's Disability Questionnaire (DEU Form 100) prior to the appointment scheduled with the Qualified Medical Evaluator. The employee will be instructed in the form and manner prescribed by the Aadministrative Ddirector to complete the questionnaire and provide it to the Qualified Evaluator at the time of the examination.

(c) The insurance carrier, self-insured employer or injured worker shall complete a Request for Summary Rating Determination (DEU Form 101), a copy of which shall be served on the opposing party. The requesting party shall send the request, including proof of service of the request on the opposing party, to the Qualified Medical Evaluator together with all medical reports and medical records relating to the case prior to the scheduled examination with the Qualified Medical Evaluator. The request shall include the appropriate address of the Disability Evaluation Unit. A listing of all of the offices of the Disability Evaluation Unit, with each office's area of jurisdiction, will be provided, upon request, by any office of the Disability Evaluation Unit or any Information and Assistance Office.

(d) When a summary rating determination has been requested, the Qualified Medical Evaluator shall submit all of the following documents to the Disability Evaluation Unit at the location indicated on the DWC AD DEU Form 101 (DEU) and shall concurrently serve copies on the employee and claims administrator:

1. Request for Summary Rating Determination of Qualified Medical Evaluator's Report (DEU Form 101) as a cover sheet to the evaluation report;

2. Employee's Disability Questionnaire (DEU Form 100);

3. Comprehensive medical evaluation by the Qualified Medical Evaluator, including the Qualified Medical Evaluator's Findings Summary Form (IMC QME Form 1002 111).

(4) A document cover sheet and separator sheet pursuant to section 10232 (b) of title 8 of the California Code of Regulation, which shall only be served on the Disability Evaluation Unit.

(e) No request for a summary rating determination will shall be considered to be received until the Employee's Disability Questionnaire DEU Form 100, the Request for Summary Rating Determination of Qualified Medical Evaluator's Report DEU Form 101, and the comprehensive medical evaluation have been received by the office of the Disability Evaluation Unit having jurisdiction over the employee's area of residence. In the event an employee does not have a completed Employee's Disability Questionnaire (DEU Form 100) at the time of his or her appointment with a Qualified Medical Evaluator, the medical evaluator shall provide this form to the employee for completion prior to the evaluation. Any requests received on or after April 1, 1994 without all the required documents will be returned to the sender.

(f) Any request for the rating of a supplemental comprehensive medical evaluation report shall be made no later than twenty days from the receipt of the report and shall be accompanied by a copy of the correspondence to the evaluator soliciting the supplemental evaluation, together with proof of service of the correspondence on the opposing party.

Authority cited: Sections 133 and 5307.3, Labor Code.

Reference: Sections 124, 4061, 4062, 4062.01, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.

§10160.1. Summary Rating Determinations, Report of Primary Treating Physician for Unrepresented Employee.

(a) For injuries on or after January 1, 1994, the insurance carrier, self-insured employer or the employee may request a summary rating of the primary treating physician's report prepared in accordance with Section 9785 9785.5.

(b) The request may be made by completing a Request for Summary Rating Determination of Primary Treating Physician's Report (DWC AD DEU Form 102 (DEU)) and sending filing the request to the Disability Evaluation Unit together with a copy of the primary treating physician's report, if the report has not already been filed in EAMS.

(c) A filed Ccopy of the request form and a copy of the primary treating physician's report must shall be served concurrently immediately after filing on the non-requesting party, including with a proof of service on the non-requesting party.

Authority cited: Sections 133, 5307.3 and 5307.4, Labor Code.

Reference: Sections 124, 4061, 4061.5, 4062, 4062.1, 4062.2, 4062.5, 4064 and 4067, Labor Code.

§10160.5. Summary Rating Determinations, Represented Employees.

(a) For injuries on or after January 1, 1991 and before January 1, 1994, the Disability Evaluation Unit will prepare a summary rating determination in cases where the injured worker is represented only if requested by a party. A summary rating determination will be prepared only upon receipt of a properly prepared request. A properly prepared request shall consist of:

(1) A completed Request for Summary Rating Determination DWC AD DEU Form 101 (DEU);

(2) An evaluation by a Qualified Medical Evaluator or Agreed Medical Evaluator.

(b) The requesting party shall complete a Request for Summary Rating Determination (DEU Form 101) and submit it together with all medical reports and medical records concerning the case to the medical evaluator. The medical evaluator shall send the completed medical evaluation report together with the Request for Summary Rating Determination to the office of the Disability Evaluation Unit designated by the Aadministrative Ddirector and specific on the Request for Summary Rating Determination (DEU Form 101) and shall simultaneously serve the party or parties requesting the evaluation.

(c) Notwithstanding the provisions of subdivision (b), a party may request a summary rating determination following receipt of a medical report prepared by a Qualified Medical Evaluator or Agreed Medical Evaluator on a represented case. The party shall send file the Request for Summary Rating Determination (DEU Form 101) and the medical report to with the DEU office designated by the Aadministrative Ddirector and shall simultaneously immediately serve a filed copy of the Summary Rating Determination the other party.

(d) If a case is settled prior to receipt of a summary rating which has been requested, the requesting party shall notify the DEU office to which the request was directed of the settlement.